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The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

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Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy. By 1988 she was living at home but was brain dead after a tragic cycle of misunderstanding, over-medication, and culture clash: "What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance." The Spirit Catches You and You Fall Down is a tragedy Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy. By 1988 she was living at home but was brain dead after a tragic cycle of misunderstanding, over-medication, and culture clash: "What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance." The Spirit Catches You and You Fall Down is a tragedy of Shakespearean dimensions, written with the deepest of human feeling. Sherwin Nuland said of the account, "There are no villains in Fadiman's tale, just as there are no heroes. People are presented as she saw them, in their humility and their frailty—and their nobility."


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Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy. By 1988 she was living at home but was brain dead after a tragic cycle of misunderstanding, over-medication, and culture clash: "What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance." The Spirit Catches You and You Fall Down is a tragedy Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy. By 1988 she was living at home but was brain dead after a tragic cycle of misunderstanding, over-medication, and culture clash: "What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance." The Spirit Catches You and You Fall Down is a tragedy of Shakespearean dimensions, written with the deepest of human feeling. Sherwin Nuland said of the account, "There are no villains in Fadiman's tale, just as there are no heroes. People are presented as she saw them, in their humility and their frailty—and their nobility."

30 review for The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

  1. 4 out of 5

    Matt

    If nothing else can be said about this book, it should be said that it will cause a reaction. Most books are a monologue. The author is telling you something and you listen. Anne Fadiman’s book is so engaging, and touches on so many sensitive subjects, that it’s more like a dialogue between author and reader. And I use the word dialogue literally. During the course of this book, I found myself audibly voicing my opinions at the page like a crazy person. My wife would ask me what I was saying, an If nothing else can be said about this book, it should be said that it will cause a reaction. Most books are a monologue. The author is telling you something and you listen. Anne Fadiman’s book is so engaging, and touches on so many sensitive subjects, that it’s more like a dialogue between author and reader. And I use the word dialogue literally. During the course of this book, I found myself audibly voicing my opinions at the page like a crazy person. My wife would ask me what I was saying, and I’d tell her “I’m not talking to you I’m talking to the book!” Sometimes I agreed with Fadiman. Sometimes I didn't. In any event, I was locked in, absorbed. The Spirit Catches You and You Fall Down is a sad, beautiful, complicated story that is ostensibly about a tragedy that arose from a clash of cultures, but is really about the tragedy of human beings. Lia Lee was three months old when she suffered her first epileptic seizure. Her parents, Nao Kao and Foua, were Hmong refugees from Laos who didn't speak any English. They took Lia to Merced Community Medical Center, a county hospital that just happened to boast a nationally-renowned team of pediatric doctors. None of those doctors spoke the Hmong language. From this initial collision – different languages, different religions, different ways of viewing the world – sprang a dendritic tree of problems that resulted in a medical and emotional catastrophe for Lia, her family, and her doctors. When Lia first came to the hospital, the language barrier – an inability to take a patient history – caused a misdiagnosis. The next time she arrived, however, she was actively seizing. Thus, her doctors were able to determine her malady and come up with a game plan on how to treat it. For a variety of reasons (both spiritual and practical), the Lees did not follow the treatment plan, and Lia didn't receive the specific care her doctors ordered. Eventually, one of her doctors filed a petition with the court to have Lia removed from the home and placed into a foster home. This allowed for a rough sort of compromise to be reached. Lia’s treatment plan was simplified and made more palatable to the Lee’s wishes. On the other hand, the Lees promised to follow the new plan as prescribed. For a time, Lia seemed to thrive. This détente looked good on the surface, but masked an unfixable wound to the relationship between the Lees and their daughter’s doctors. By the time the final seizure came for Lia Lee, her family actively distrusted the people working at the Merced Community Medical Center. Fadiman intercuts her narrative of Lia Lee’s care with sections on the history of the Hmong in general and the journey of the Lees in particular. The Hmong people are an ethnic group who once lived in southern China. The Chinese pushed many of the Hmong from their borders, and they ended up living in Burma, Vietnam, Thailand, and Laos. During the Vietnam War, the CIA secretly recruited the Hmong to fight against Communism. When America pulled out of Vietnam, a Communist government in Laos persecuted the Hmong, and many fled the country in fear of their lives. The Lees left northwest Laos, spent time in a Thai refugee camp, and eventually ended up in California, where Lia was born. Fadiman explores the complicated system of rituals and beliefs that govern traditional Hmong life. The Lees, like many Hmong, are animists, with a belief in a world inhabited by spirits. This faith dictated how the Lees understood Lia’s illness and how they wanted it treated: When Lia was about three months old, her older sister Yer slammed the front door of the Lees’ apartment. A few moments later, Lia’s eyes rolled up, her arms jerked over her head, and she fainted. The Lees had little doubt what had happened. Despite the careful installation of Lia’s soul during the hu plig ceremony, the noise of the door had been so profoundly frightening that her soul had fled her body and become lost. They recognized the resulting symptoms as qaug dab peg, which means “the spirit catches you and you fall down”…On the one hand, it is acknowledged to be a serious and potentially dangerous condition…On the other hand, the Hmong consider quag dab peg to be an illness of some distinction. I read The Spirit Catches You and You Fall Down for my Husband’s Book Club (a shadow book club created after all our wives started one of their own). It came as a surprise pick from one of our quieter members, but proved to be one of our best choices. There are a lot of things to discuss. A veritable cornucopia of debate, dissention, and gentlemanly disagreement: Vietnam, CIA, Laos, and the debt owed the Hmong; refugee crises and how they are handled; the assimilation of refugees and immigrants; and even end of life decisions. We met to discuss this book at a local brew pub where we could drink IPAs and eat pretzels with cheese. Most of us got pretty drunk. Usually, six drunks sitting around a table can solve most of the world’s problems. In this case, though, we mostly ended up in total divergence. I think that’s a testament to Fadiman’s willingness to take on every third rail in modern American life: religion, race, and the limits of government intervention. (An aside: One of Fadiman’s chapters, called “The Life or the Soul,” posits the question of whether it is more important to save someone’s life (in which medical decisions trump all) or their soul (in which a person wouldn’t receive certain treatments that contradicted their deeply held beliefs). I’m not sure if it was the high alcohol content by volume in the beer, but the Husband’s Book Club somewhat surprisingly split 3-3 on the issue). Judging from other reviews I’ve read, this is a book that angered people. Much of the vitriol is aimed at the Hmong who are accused, among other things, of being welfare mooches (this book was published right before Clinton signed the Personal Responsibility and Work Opportunity Act, gutting welfare); of ingratitude for the millions of dollars of free medical care they received; of parental negligence; and for their refusal to assimilate into American society. If you read this book and only feel anger…Well, I’d never tell someone they’re reading a book wrong, but in this case, you’re clearly reading this book wrong. These are difficult, fraught topics that Fadiman handles with grace. There are no heroes and villains. There are only individuals doing the best they can with what they have, based on who they are. It should also be noted that Fadiman is a beautiful writer, and in terms of sheer journalistic enterprise, I’ve rarely stumbled across a better example of diligent, on-the-ground research. Fadiman isn’t out to piss people off. She does not structure her book to lay blame at anyone’s feet. Nevertheless, the central conflict of her story pits the Lees verses her doctors. Who was responsible for Lia’s fate? The parents who did not follow their doctors’ orders? Or the doctors, who never took the time to understand their patient, her family, and the context in which they lived their lives? On this question, Fadiman is admittedly biased. It is a gentle bias. She faults the doctors for a lack of cultural curiosity, yet admits that – in order to gain the Lees’ trust – she spent hundreds and hundreds of hours with them, speaking to them through a handpicked interpreter. The time she spent allowed her to see the Lees as fully formed people, not the seemingly-ignorant, oft-mute “other” that presented at the hospital. She recognizes that it’s hardly reasonable for any doctor to spend hundreds of hours with a single patient just to understand how they view the world. There are moments where I think that Fadiman is rather a bit too hard on some of her non-Hmong interview subjects. She gets intensely irritated with a waitress who says the Hmong are bad drivers. (I don’t know why this angered her. It’s perfectly rational to think that the Hmong, unable to understand American traffic signs, might be terrible behind the wheel. My dad and I once drove from Paris to Normandy. Neither of us speak French. We were honked at the entire time. Literally. The entire time. Don’t know why. To this day we don’t know why). Her sympathies lie with the Lees, and perhaps rightly so; yet she isn’t quite willing to extend the same empathy or generosity of viewpoint to others she comes across. I wonder if she’d have the same tolerance for a white anti-vaxxer who doesn’t have their kid inoculated for a deadly disease, or a Jehovah’s Witness who refuses consent for a child’s blood transfusion. I like to think of myself as generally broadminded, with a liberal and accepting heart. Like Jesus, with more wine. As a parent, though, I found myself periodically raging against the Lees. This is your kid! Give her the correct prescriptions! Just do it! At the same time, I recognize the need for doctors to better remember their patients are people. I’ve dealt with a chronic medical condition for the last couple years that has sent me on a semi-desperate search for a specialist who would listen to me. I’m a college-educated white male with health insurance who often wore a business suit to my appointments since I came straight from work. If I couldn’t get a doctor to give me five minutes of uninterrupted time, I can only imagine the experience of an indigent, non-English speaking patient who walks into the hospital with a life experience 180-degrees different from his or her physician. One of the book’s final chapters, “The Eight Questions,” provides a nice roadmap for doctors. The titular questions, devised by a Harvard Medical School professor, are a deceptively simple, brilliant way of allowing the doctor and patient to share roughly-equal footing in the patient’s treatment. It shouldn’t be a binary question of the life or the soul, with the doctor standing in for God. When I love a book, I talk to people about it. In doing so, I found that it’s on a lot of different curriculums. One of my friends read it for an undergrad ethics course. Another of my buddies, we’ll call him Dr. B, had it assigned while he was in medical school. ME: Did you read it? It’s really good. DR. B: No. ME: Why not? DR. B: Because I was studying medicine. His answer is what I expected, and why I hope this book continues to get read. (Final aside: The Spirit Catches You and You Fall Down was researched in the 80s and published in the 90s, meaning that the Hmong experience in America has changed. I recommend getting the Fifteenth Anniversary Edition with a new Afterword by Fadiman. The Afterword provides a nice little update, as well as the cathartic tying of some loose ends).

  2. 4 out of 5

    Lisa Vegan

    I knew a little about this case, and before I read the book, I was certain I’d feel infuriated with the Hmong family and feel nothing but disrespect for them, and would side with the American side, even though I have my issues with the western medical establishment as well. Not that I didn’t feel angry (and amused) at times with both sides, but I also ended up empathizing with the people in both sides of this culture clash, which is a testament to Anne Fadiman’s account of the events. My culture I knew a little about this case, and before I read the book, I was certain I’d feel infuriated with the Hmong family and feel nothing but disrespect for them, and would side with the American side, even though I have my issues with the western medical establishment as well. Not that I didn’t feel angry (and amused) at times with both sides, but I also ended up empathizing with the people in both sides of this culture clash, which is a testament to Anne Fadiman’s account of the events. My culture is definitely that of an American (well, a subculture anyway, as there are obviously many cultures within America!) and I am fairly wedded to it, but I really appreciated this look into a culture so different from my own. Anne Fadiman does a remarkable job of communicating both sides of this story; it’s probably one of the best examples of cross-cultural understanding that I’ve ever read. It’s ostensibly about a young Hmong girl with epilepsy and her family’s conflict with the American medical establishment, and there is much about them here. But it’s also a wonderful history book. There’s much background about the Hmong people going back centuries and recent history also. It also made me sympathize with the difficulties of the immigrant experience, especially for those who settle in a place so different from their homeland. I learned so much about the Hmong people; I knew very little before reading this book, and what I knew contained some inaccuracies or at least a lack of context. And, as I was reading, I was really struck by how cultural differences (and the cultural differences between the Hmong and American cultures is about as far apart as it gets) can completely hinder communication if they’re not acknowledged and attempts are made to bridge the gap. This is a great book to read if you want to try to understand any people who are different from you in any way. Beautifully written and an enjoyable read.

  3. 4 out of 5

    Inder

    This is the heartbreaking story of Lia, a Hmong girl with epilepsy in Merced. It is intended to be an ethnography, describing two different cultural approaches to Lia's sickness: her Hmong parents' and her American doctors'. Don't read any further unless you don't mind knowing the basic story told in this book (there are no spoilers, since this is not a book with a surprise ending, but if you want to keep a completely open mind, stop now) ... I have wavered between four and five stars for this on This is the heartbreaking story of Lia, a Hmong girl with epilepsy in Merced. It is intended to be an ethnography, describing two different cultural approaches to Lia's sickness: her Hmong parents' and her American doctors'. Don't read any further unless you don't mind knowing the basic story told in this book (there are no spoilers, since this is not a book with a surprise ending, but if you want to keep a completely open mind, stop now) ... I have wavered between four and five stars for this one. The book is so beautifully and compassionately written - you feel for absolutely everyone in the story. Like Lia's doctors, you can't help but feel frustrated with Lia's noncompliant, difficult, and stubborn parents. At the same time, given their history, you can fully appreciate her parents' dislike of hospital procedures and distrust of distant, superior American doctors. There are no heroes or villains here. The book is perfectly balanced. When Lia ends up brain dead, your heart just hurts for everyone involved. There are a couple of reasons I finally settled on four stars: (1) While the historical background provided in the book is excellent, it drags the story down. I felt it could have been better incorporated into an otherwise almost flawless narrative. (2) I found myself questioning the basic premise of the book. I'm not sure that cultural misunderstandings caused Lia's eventual "death" (brain-death, that is). Lia's epilepsy, by all accounts, was unusally severe and unresponsive to medication. So I was never convinced that a white, middle-class American girl would have survived with her mind in tact, either. This is not to dismiss the very real cultural struggle that this book describes, but some of the author's statements about how cultural misunderstandings "killed" Lia seemed a bit speculative to me. But overall, this is an absolutely beautiful, touching book, and should be required reading for everyone in California (and everyone else, too).

  4. 5 out of 5

    Teresa

    A book like this one should be required reading for anyone who lives in a community of multicultural members, and nowadays that's probably just about everyone. Sadly, and not surprisingly, those who would probably most benefit from a book like this would probably be the ones least likely to read it. It's an eye-opener on cross-cultural issues, especially those in the medical field, but also in the religious, as the Hmong don't distinguish between the two. In understandable and compelling language A book like this one should be required reading for anyone who lives in a community of multicultural members, and nowadays that's probably just about everyone. Sadly, and not surprisingly, those who would probably most benefit from a book like this would probably be the ones least likely to read it. It's an eye-opener on cross-cultural issues, especially those in the medical field, but also in the religious, as the Hmong don't distinguish between the two. In understandable and compelling language, it also explains the background of the Hmong (historically, a migrating people without a country) and their CIA-recruited role in the American War in landlocked Laos, a place they didn't want to leave but were forced out of, and how so many of them ended up in Merced, CA. There's a lot to learn here, but the most important thing for me was the, perhaps needless, conflict and heartbreak that can result when bureaucracies try to fit everyone into their one-does-not-fit-all pigeonholes.

  5. 4 out of 5

    Eric

    This is one of the best books I've read. I guess it would be considered part of the medical anthropology genre, but it's so compelling that it sheds that very dry, nerdly-sounding label. This was recommended to me in a cultural literacy course and it certainly delivered. The story is of the treatment of the epileptic child of a Hmong immigrant family in the American health system. The issue is the clash of cultures and the confusing and heartbreaking results. And the takeaway lesson is in how to This is one of the best books I've read. I guess it would be considered part of the medical anthropology genre, but it's so compelling that it sheds that very dry, nerdly-sounding label. This was recommended to me in a cultural literacy course and it certainly delivered. The story is of the treatment of the epileptic child of a Hmong immigrant family in the American health system. The issue is the clash of cultures and the confusing and heartbreaking results. And the takeaway lesson is in how to conduct your life once you realize that you really have no idea what underpins most other people's framework of reality and have no claims on the truth. It makes you want to beat a hasty retreat from judgment and be a better person. It makes you want to listen more, forgive more, learn more about people, and allow for more realities. It's an important certainty-challenger. Highly recommended.

  6. 5 out of 5

    Beverly

    In Hmong culture they revere their children so much, it is wonderful. This little girl was her parent's favorite and they believed her epilepsy was a special gift that made her more in tune with the spirit world. Many of the spirit healers in Hmong society have epilepsy. More largely, this is the story of a clash between western and eastern cultures, a communication lapse that ultimately ended up hurting the parents of this little girl very profoundly.

  7. 4 out of 5

    Hamad

    The Spirit Catches You And You Fall Down may read like a documentary (thanks to Fadiman’s journalistic background), but it is really an introspection on the western system of medicine and science. We cannot ourselves metaphorically stand back and try to look at the system from the outside. However, comparing it to another (supposedly antithetical) system through the experiences of the Hmong refugees can be used as a tool to do just that. The Hmong’s presumed non-separation of any of the dimensio The Spirit Catches You And You Fall Down may read like a documentary (thanks to Fadiman’s journalistic background), but it is really an introspection on the western system of medicine and science. We cannot ourselves metaphorically stand back and try to look at the system from the outside. However, comparing it to another (supposedly antithetical) system through the experiences of the Hmong refugees can be used as a tool to do just that. The Hmong’s presumed non-separation of any of the dimensions of life (least of all the physical) is a good contrast to the western notion of categorization and separation of the physical, emotional, spiritual and mental. This categorization is a manifestation of the desire for control – labeling and naming are just the initial objectives of this desire. In contrast, the Hmong view control quite differently. Given such vast differences on such fundamental aspects, one wonders if the result could have turned out another way at all. Categorization and classification is the ‘bread-and-butter’ of science. It is supposed to be ‘rational’ and evidence-based. Western medicine seems to not only classify problems into different aspects of the overall human – physical, mental, emotional and spiritual, it tends to also over-categorize – different physicians for different organs or diseases, specialization etc. On the other hand, according to Fadiman, the Hmong don’t even bother with the separation of these different aspects; they do not even have a concept of ‘organs’ making up a human body. There is definitely no separation between the physical and the spiritual. Fadiman’s observation of the Hmong obsession with American medicine and the behavior and attitudes of American doctors delineates this point clearly. This lack of categorization also goes beyond the individual and is reflected by a relatively classless structure of Hmong society: Fadiman points out that the Hmong do not separate themselves by class, and live by a more egalitarian standard. The need to classify and categorize stems from a desire to control. By classifying organisms into different species, genus or families, we try to exert control over nature. By categorizing people according to gender, class and race we try to assign people different roles and duties, further illustrating society’s desire to control individual lives - to maintain ‘order’. This desire is more so present in medicine, where we explicitly try to control disease, pain, suffering and eventually life (or death). Since the Hmong concepts of separation are close to non-existent, their view is that of ‘letting go’. Fadiman observes how holistic their approach is compared to the approach of the American physicians by showing that even though the Lees cared a great deal for Lia (and loved her unconditionally), they still tried to persuade the spirit to let go of Lia’s soul so it would come back to her. The American doctors, however, got progressively invasive trying, in vain, to assert more control over the situation by intubating, restraining and over-prescribing. Given this discordance in the fundamentals of each culture’s worldview, the question that begs to be answered is: could things have gone differently? The Lees at one point acceded that they would be willing to use a combination of therapies both from their culture and their recently adopted culture, but would the physicians have complied to it as well? Given the history of discrimination in this country, would it be wise to go back to ‘separate but equal’? These are only some of the questions that arise from the book. There may be fundamental differences between two cultures, but could there also be fundamental similarities?

  8. 4 out of 5

    Mmars

    There are so many valuable aspects to this book it's hard to decide what to mention. Having just learned that Lia, the subject of the book, passed away within the last week I'd like to express sheer admiration to her family, and especially her parents, for loving and caring for her for so many years. Along with a large influx of Hmong, Lia lived in Merced, CA when she experienced her first seizures. The Hmong and their language and their culture were yet virtually unknown and entirely misunderst There are so many valuable aspects to this book it's hard to decide what to mention. Having just learned that Lia, the subject of the book, passed away within the last week I'd like to express sheer admiration to her family, and especially her parents, for loving and caring for her for so many years. Along with a large influx of Hmong, Lia lived in Merced, CA when she experienced her first seizures. The Hmong and their language and their culture were yet virtually unknown and entirely misunderstood in America at this time while Mia and her family knew only their own culture and language. What ensues is a series of missteps, mistakes, and, again misunderstandings. This is an eye-opening account of multiculturalism, social services, and the medical community. There were and are no easy answers, but there always are lessons to be learned, and a lot can be learned from this book. I found it a fascinating read, clearly written. It is heartening to learn that this book is being used in educational settings. A must read for anyone who works in a field involving interaction with peoples of various cultures as well as lay readers.

  9. 5 out of 5

    Heather

    Anne Fadiman addresses a number of difficult topics in her depiction of a Hmong couple's quest to restore the soul to their child. While I consider myself a culturally sensitive individual, having been raised in a family of doctors and nurses, I have long held the conviction that the world's best doctors (whether imported or native) tread on American soil. Reading Fadiman's account (which sometimes includes actual excerpts from the patient's charts), I was forced to take a hard look at my assump Anne Fadiman addresses a number of difficult topics in her depiction of a Hmong couple's quest to restore the soul to their child. While I consider myself a culturally sensitive individual, having been raised in a family of doctors and nurses, I have long held the conviction that the world's best doctors (whether imported or native) tread on American soil. Reading Fadiman's account (which sometimes includes actual excerpts from the patient's charts), I was forced to take a hard look at my assumptions. In the course of reading this book, I have redefined my idea of what constitutes a good doctor. Fadiman spent hundreds of hours interviewing doctors, social workers, members of the Hmong community--anyone who was somehow involved in Lia Lee's medical nightmare. She pored over years of medical records, trying to make sense of the events that caused a spirited, loving toddler to slowly devolve into a vegetative state. What she found was that the doctors' orders, prescribed medications, hospital care, etc., were all based on a number of Western assumptions that did not take the family's (and child's) best interests into consideration. No attempt was made to understand how the family saw the disease or what efforts they were making on their own to address the situation. More than a translator, what doctors and other professionals involved in Lia's case needed was a "cultural broker" who could have stepped in and possibly saved Lia's brain from further deterioration. Fadiman's book is a difficult read, not because of specialized vocabulary or lofty philosophical concepts, but because there comes a point when the reader realizes that the barriers faced by those involved were much more cultural than they were linguistic. In a very real way, the Lees inhabited a different world than the doctors, and vice-versa. Each assumed that their way was best, and neither made a genuine effort to understand the other's motivations, much less their logic. In the end, there was no simple solution to their plight, but more mutual respect and understanding of the differences between the cultures would have benefitted everyone involved. If there is a moral to Fadiman's work, it may be this: The best doctors are not those who know the most, but rather those who admit what they do not know, and try to understand the full picture. Good doctors may treat the disease, but the best doctors treat the individual.

  10. 4 out of 5

    Robbin

    i read this book for a class i am taking called "human behavior and the social environment." it tells the story of a Hmong family in california with a little girl who has epilepsy. their experience as refugees who are illiterate and unable to speak english, traversing the american medical system ends up tragic. however, the author is really good at giving voice to both sides, the western doctors (impatient, overworked, stubborn, judgmental, dedicated) and the Hmong family (impatient, overworked, i read this book for a class i am taking called "human behavior and the social environment." it tells the story of a Hmong family in california with a little girl who has epilepsy. their experience as refugees who are illiterate and unable to speak english, traversing the american medical system ends up tragic. however, the author is really good at giving voice to both sides, the western doctors (impatient, overworked, stubborn, judgmental, dedicated) and the Hmong family (impatient, overworked, stubborn, judgmental, loving). at their wit's end the doctors have the little girl removed from the home and placed into foster care. the foster family not only falls in love with lia (the epileptic toddler) but they fall in love with the family. perhaps, the first and only time in history the foster mother even allows the so-called abusive mother baby-sit her OWN children while she takes lia to one of her appointments. through a series of events lia ends up in a vegetative state (and at that point her epilepsy in her brain dead state is actually cured), and she is returned home to die. but she doesn't. the Hmong family keeps her alive with their love and care, something the doctors had never witnessed. on their own terms, they continue to feed her, bathe her, and watch over her literally 24 hours a day (she sleeps in the bed with the mother every night). she continues to grow with rosy skin and healthy hair, and the Hmong family continues to believe that the western doctors and their medicine actually made her seizures and illness worse. anyone going into the medical/social work/psychology field should read this book. what could be lost in the story is the background the author gives to the story of the Hmong, a culture and people that have been continuously marginalized and persecuted in every society they have lived in. nomadic to escape assimilation, they remain a strong and loyal group of people with a complex system of justice and care. they also fight the US government's "secret war" against the communists and bare the brunt of the CIA's unsuccessful agenda.

  11. 5 out of 5

    Merritt

    An interesting story that highlights the many cultural differences between Americans and our immigrants (in this case the Hmong culture). Lia Lee is a Hmong child with severe epilepsy and the American doctors trying to treat her clash over her entire life with her parents, who are also trying to treat her condition. Fadiman walks a fine line in describing the story fairly from both perspectives; however, it's difficult, as an American, to not feel some anger toward this girl's family. I learned An interesting story that highlights the many cultural differences between Americans and our immigrants (in this case the Hmong culture). Lia Lee is a Hmong child with severe epilepsy and the American doctors trying to treat her clash over her entire life with her parents, who are also trying to treat her condition. Fadiman walks a fine line in describing the story fairly from both perspectives; however, it's difficult, as an American, to not feel some anger toward this girl's family. I learned of some hidden prejudices in myself: faith healing vs. medicine and a family's right to choose between them for a minor child especially, and to a lesser degree, a prejudice towards immigrants that live off of our health care and tax dollars without contributing to the national coffers. I was particularly uncomfortable with that last one because I respect people's right to look for a better life but apparently I want them to do so legally and not take advantage of our hospitality for several years. It's not one of my favorite books but it's interesting.

  12. 5 out of 5

    Katie

    4.25-ish LOVED

  13. 4 out of 5

    K

    "The Spirit Catches You and You Fall Down" explores the tragedy of Lia Lee, a Hmong child with epilepsy who eventually suffered severe brain damage, from a variety of perspectives. One perspective is that of her family, who believed that epilepsy had a spiritual rather than a medical explanation, and who had both practical difficulty (as illiterate, non-English speaking immigrants to the U.S.) and general reluctance to comply with Lia's complicated medical regimen. Another perspective is that of "The Spirit Catches You and You Fall Down" explores the tragedy of Lia Lee, a Hmong child with epilepsy who eventually suffered severe brain damage, from a variety of perspectives. One perspective is that of her family, who believed that epilepsy had a spiritual rather than a medical explanation, and who had both practical difficulty (as illiterate, non-English speaking immigrants to the U.S.) and general reluctance to comply with Lia's complicated medical regimen. Another perspective is that of her doctors, who were extremely frustrated at all the barriers in dealing with this family and felt understandably determined to treat Lia according to the best standards of medicine. Then you have the people in between -- the sympathetic and aggressively advocating social worker (resented by the doctors) who came from the American point of view but aligned with the family; Lia's temporary foster family who ended up forming an apparently close relationship with her birth family; and the author herself, who unpacked this story with all its layers and recognized the profound questions it elicited, such as: What’s preferable from a doctor’s point of view – a lower standard of care with a higher probability of compliance from the family, or a higher standard of care with a lower probability of compliance from the family? When a child is involved, who's the boss -- the doctor, or the parents? Why are we Americans so intolerant of those who do not wish to assimilate into our culture? And do we owe them the same rights/privileges as those who adopt American culture? How could the Lees be perceived so radically differently by the doctors and nurses who worked with them vs. the more sympathetic social worker and journalist? If the doctor's goal is to save the body and the family's goal is to save the immortal soul, who should win that conflict? This book was amazing, on so many levels. The writing was excellent, and so was the organization. I find that non-fiction books often err on the side of being either informative but too dry, or engaging but also too sensationalist/one-sided. This book was neither. The story was gripping, and so was the background (and Fadiman did a great job of interspersing the two so as to build tension, and so that neither aspect of the book ever got boring). Fadiman has clearly done her research, and I felt like I learned a great deal from the book but never felt like I was reading a textbook. Best of all, this is one of the rare books I've read that felt truly balanced and three-dimensional. Fadiman was sympathetic to the Hmong and their viewpoint without romaticizing or idealizing them. She described some unfair racist reactions to the Hmong, but she also acknowledged the valid resentment felt by people whose taxes were supporting their welfare-receiving huge families. Fadiman also portrayed the doctors as motivated overall by good intentions. She acknowledged factors such as cultural blindness and the arrogance of the profession, but did not imply that the doctors were coldhearted, insensitive automatons -- quite the contrary. Highly recommended for anyone who wants an engaging and thought-provoking read.

  14. 5 out of 5

    Crawford

    Educational warning: This book will teach you something important about non-compliant patients. The title of The Spirit Catches You and You Fall Down is the literal translation of the Hmong words for epilepsy. All doctors know about epilepsy; virtually none know about the Hmong people. They are an ethnic group who lived in China for hundreds of years. The Hmong have often been thought of as "outsiders." Over the centuries they have resisted taming by various domineering governments and oppressors. Educational warning: This book will teach you something important about non-compliant patients. The title of The Spirit Catches You and You Fall Down is the literal translation of the Hmong words for epilepsy. All doctors know about epilepsy; virtually none know about the Hmong people. They are an ethnic group who lived in China for hundreds of years. The Hmong have often been thought of as "outsiders." Over the centuries they have resisted taming by various domineering governments and oppressors. When things get tough the Hmong often move on. In recent times their main homeland has been in Laos. During the Vietnam war and its aftermath things got particularly difficult for the Hmong, and many ended up in the United States. Some came as a reward for having fought on behalf of the Americans as part of the little known Laotian Armée Clandestine. The Lee family, the subject of this account by the journalist Anne Fadiman, left their home in Laos and now live in Merced County, California. They spent some time in two Thai refugee camps before they came to the US. The Lee’s 14th child, Lia, was the first to be born in the US. When she was about 3 months old Lia had her first epileptic fit. Her mother and father, Foua and Nao Kao, immediately made the correct diagnosis. And they knew the cause of the problem: Lia’s soul had fled her body and become lost. As loving parents they were, of course, concerned about the loss of their daughter’s soul. The epilepsy was less of a problem for them, because epileptic people have a special place in their society, and many Hmong people with epilepsy go on to becomes healers and shamans. Much of the rest of the book—I don’t want to ruin it for you—is the story of how caring California doctors failed to tune in to the Lees’ interpretation of their daughter’s epilepsy. US paediatricians, it seems, don’t know how to find a lost Hmong soul. (The US medical curriculum has other gaps: it doesn’t include other common causes of illness, such as urinating on a rock that looks like a tiger and failing to ejaculate completely during sexual intercourse.) I first read this book about 10 years ago. Since then it has frequently impinged on my consciousness in my working life as a GP. Although it is a tale about an unknown family from a faraway place, it exemplifies all the things that make for a great medical classic. In such a work I look for durability, excellent writing, and some messages that will outlast fashion. If I’m lucky I will also find humour, exceptional humanity and insight, and a gripping narrative. Ten years after my first reading it is just as exciting as when I first picked it up. The writing is economical and correct—not too many adjectives, but superb descriptions of people and events. The sentiments are deeply human, the storyline is compelling, and the book has helped me understand some of my most puzzling patients. No medical student should be allowed to graduate without reading this book. Doctors who are infuriated by their patients’ lack of "compliance" should read it without delay. Cite this as: BMJ 2010;341:c3524

  15. 4 out of 5

    Samantha Newman

    I never would have chosen this book to read on my own. So I must thank Eliza for lending it to me. (I now feel like lending/recommending a book proves friendship...) I didn't know anything about Hmong culture and now I do. This book also taught me about the American medical system - it looks strange when you step back. It would have been a good book for me to read when I was in Japan, too, because it kind of opened me up to the idea that people of other cultures can really be sooo different. It's I never would have chosen this book to read on my own. So I must thank Eliza for lending it to me. (I now feel like lending/recommending a book proves friendship...) I didn't know anything about Hmong culture and now I do. This book also taught me about the American medical system - it looks strange when you step back. It would have been a good book for me to read when I was in Japan, too, because it kind of opened me up to the idea that people of other cultures can really be sooo different. It's not stupidity, it's not lack of common sense, whatever. It's the fact that there are so many different cultures in this world, and growing up in any one of them makes just about everything about you so totally different from those in other societies. And is there any way to bridge those gaps completely? I don't think so. There's probably a way to improve cross-cultural relations though. Especially in a place like the US. This book brings up those questions and doesn't pose solutions but does give ideas at least to open up your mind and eyes to it all. And it gives facts about how things have been (poorly) dealt with, and the problems that causes. The case study Fadiman explores is a perfect example that you can kind of project onto other situations. And the story itself is really interesting. Fadiman tells the story rather skillfully - (but?) you can tell she is a journalist, for better or worse, here. This book was really enjoyable. It impressed me and taught me a lot and made me think about the issues it brought up - namely cultural issues - a lot. I'm glad I read it and I hope I keep it in mind when I encounter those from other cultures and have difficulties with how I may feel about them. Because I can pretend I'm not "culturalist" and I'm all open and accepting but when it comes down to it, I'm not.

  16. 4 out of 5

    Chelsea

    Fadiman wrote a fascinating and sympathetic story about a culture that couldn't be much farther removed from ours in the West. It was especially interesting reading it right after Hitchen's God Is Not Great, because, theoretically, had there been no religion involved there wouldn't have been a real culture clash, and Lia could have grown up as an epileptic but functioning girl. Maybe. But that's not really the point of Fadiman's book: she doesn't condemn anyone, and, in fact, she points out that Fadiman wrote a fascinating and sympathetic story about a culture that couldn't be much farther removed from ours in the West. It was especially interesting reading it right after Hitchen's God Is Not Great, because, theoretically, had there been no religion involved there wouldn't have been a real culture clash, and Lia could have grown up as an epileptic but functioning girl. Maybe. But that's not really the point of Fadiman's book: she doesn't condemn anyone, and, in fact, she points out that there isn't anyone person or group who can be blamed for what happened to Lia. The point of the book is to take a look at the differences in cultures that exist in our country today, and maybe realize that there are better ways of dealing with the issues that arise. The look at the Hmong culture and history the book provides is fascinating and enlightening. The different levels of engagement the Lee family had with various westerners was particularly telling, and explained a lot about the wildly varying opinions people had formed. The story of Lia Lee is tragic, and the possibility that it could have turned out differently makes it especially so. It's been over ten years since the book came out, and I would love to have some kind of update as to how the Lee family is doing - especially how Lia is doing - and if there has been any real progress made in solving culture collisions in Mercer.

  17. 4 out of 5

    Claudia Putnam

    In graduate school (comparative religion), I took a class called ritual, illness, and the body. This book came out just a few years later. Though we studied other fascinating examples of medical anthropology looking at Western, especially American, practices, it would have been wonderful to be able to use this text. Though doctors today more often take courses in cross-cultural awareness in med school, it's still just a small portion of their training, if they get it all. This book is highly rel In graduate school (comparative religion), I took a class called ritual, illness, and the body. This book came out just a few years later. Though we studied other fascinating examples of medical anthropology looking at Western, especially American, practices, it would have been wonderful to be able to use this text. Though doctors today more often take courses in cross-cultural awareness in med school, it's still just a small portion of their training, if they get it all. This book is highly relevant a couple of decades after publication, not just to the medical community but to all of us. We all need to make further strides in understanding the Other, whether living in the dominant culture or not--Fadiman explicates the assumptions of the medical community as well as she strives (I'm sure her understanding only begins to approach the worldview of the Hmong, no matter how hard she tried) to get at traditional societies. Beyond the tragic misunderstanding that resulted in the irreversible brain death of a beautiful Hmong child, there is a lot to contemplate here. I thought a lot about the Amish, for instance, who have been allowed to live as they please and believe. Yet, the Hmong asked for no more--some land of their own and the ability to go on living as they too believe. They fought bravely for us in Laos and were made refugees because the overspill of our policies in Indochina. They had no interest in assimilating to American culture. They did not come here because of American opportunities, but because they had nowhere else to go as a result of our policies. The only opportunity they found attractive about America was a thing they had heard about: Freedom. But they did not find it here... to them it would mean a freedom to pursue their shamanic, agricultural, mountain lifestyle with its animistic beliefs and animal sacrifice. And if the Amish can do as they please, including being granted the ability to be conscientious objectors in wars, why shouldn't these fighters get they land they ask for and the freedom to follow their religion and lifestyleIt's just a question. Why indeed, do we require that ALL refugees merge into American society? Why can't it be case by case? Some, like many Southern and Central Americans, come here seeking relief from the oppression of their own societies and the alternatives and opportunities presented by America, just as the ancestors of Euro-Americans did. Others come as a result of American policies abroad. It seems we ought to allow for these distinctions. Fadiman does not directly raise this point. It's only implied. Meanwhile, there are a lot of other direct points about how working with shamans and other native beliefs and family systems can help families agree to, say, use Western medicine AS WELL. And perhaps help doctors, too, be less dismissive of indigenous ways of seeing things. The doctors in this California community tended to dismiss the Hmong, inventive guerillas capable of holding off large invasive forces, as stupid and primitive. Nor did they have any idea of their traumatic pasts. Or how difficult it had been to translate a highly adaptive skill set in their old land to things like apartment buildings and suburban lifestyles. Canned food. It wasn't that they were too stupid to figure it out, but that they were skeptical of the value, and not too different, in some ways, from large groups of Americans who are increasingly reluctant to accept conventional Western medicine at face value. Well written, moving, and worth the read.

  18. 4 out of 5

    Book Concierge

    Subtitle: A Hmong Child, Her American Doctors, and the Collision of Two Cultures The 150,000 Hmong refugees who came to the United States in the late 1970s arrived in a country and culture that could not have been more foreign to them. The Lee family had escaped their native village in the hills of Laos and settled in Merced California. In July 1982 Foua Yang gave birth to her fourteenth child; Foua and her husband Nao Kao Lee would name the little girl Lia. She was a loved child, tenderly cared Subtitle: A Hmong Child, Her American Doctors, and the Collision of Two Cultures The 150,000 Hmong refugees who came to the United States in the late 1970s arrived in a country and culture that could not have been more foreign to them. The Lee family had escaped their native village in the hills of Laos and settled in Merced California. In July 1982 Foua Yang gave birth to her fourteenth child; Foua and her husband Nao Kao Lee would name the little girl Lia. She was a loved child, tenderly cared for and pampered as the “baby” of the family. When she was about three months old, however, Lia had a seizure. Her parents believed this was caused when her older sister had slammed the front door of their apartment, drawing the attention of a spirit who had caught Lia’s soul. The Hmong call this condition quag dab peg and consider it something of an honor to have these spirits possessing the child; such a person might even grow up to become a shaman. Still, the frequency and severity of the seizures worried Foua and Nao Kao enough that they took Lia to the Merced County Medical Center Emergency Room. There the lack of a common language or trained interpreters, and the clash of cultures led to disastrous results. This is a fascinating medical mystery, and a balanced exploration of two very different points of view. No one acted with malice, everyone wanted what was best for Lia, but there was no way for the two opposing sides – Lia’s parents and community vs the doctors and social workers – could come to agreement. And the person who suffered was Lia. I thought the book could have used more editing. Perhaps Fadiman believed that the reader needed considerable repetition to get the message (and she may be right about that), but I really didn’t’ need to be told – again – that the Lees believed a spirit was the cause of Lia’s problems, or that they believe the medicine made her worse, or that the doctors thought the Lees were difficult or poor parents. Still, I was really caught up in the story, and appreciated learning more about the Hmong culture. I’m looking forward to my F2F book club’s discussion on this book.

  19. 4 out of 5

    Sarah

    Amazing book. In my work with people with developmental disabilities and epilepsy, I've seen a lot of examples of the disconnect between doctor and patient -- and that's even when both speak a common language and have a common cultural understanding of their roles. This book tells the story of an extreme example, in which the patient's parents neither understood the doctors nor trusted them, and the medical system held a reciprocal inability to understand where the family was coming from. In tel Amazing book. In my work with people with developmental disabilities and epilepsy, I've seen a lot of examples of the disconnect between doctor and patient -- and that's even when both speak a common language and have a common cultural understanding of their roles. This book tells the story of an extreme example, in which the patient's parents neither understood the doctors nor trusted them, and the medical system held a reciprocal inability to understand where the family was coming from. In telling this one story, the author also goes into the history and culture of the Hmong people both in Laos and the US. It is both riveting and devastating. My one initial irritation was with the author's continual use of the term "epileptic", which is very much out of favor right now, but wasn't at the time that she wrote the book. The preferred term is "people with epilepsy", in order to stress that individuals with the disorder are not identified solely by their symptoms. I got used to her archaic terminology over the course of the book, and I'm sure the author would be the first to agree with the spirit behind the change.

  20. 5 out of 5

    Naeem

    So close and yet so far. Fadiman sets up an epistemological encounters between US doctors and Hmong culture. The life of a young woman is at stake. The book is well written, well researched, and Fadiman's heart seems to be in the right place. The book fails however. Ultimately, as hard as she tries, Fadiman cannot overcome her biases. That would be less of a problem if she did not want to come across as "objective." A touch of theory and a bit of world history might have been enough to take Fadima So close and yet so far. Fadiman sets up an epistemological encounters between US doctors and Hmong culture. The life of a young woman is at stake. The book is well written, well researched, and Fadiman's heart seems to be in the right place. The book fails however. Ultimately, as hard as she tries, Fadiman cannot overcome her biases. That would be less of a problem if she did not want to come across as "objective." A touch of theory and a bit of world history might have been enough to take Fadiman from a book that is quite good to one that is a contribution to our understanding of others. I recommend this book as an example of how close one can come to understanding and still miss it.

  21. 5 out of 5

    Miklos

    Is it terrible that I found myself sympathizing with the doctors and that the family was getting in the way of treating their childs illness?

  22. 4 out of 5

    Polly Vella

    This book was so interesting and very moving. I learned a lot about the Hmong community that has settled in many parts of the United States. The Hmong are mostly from Laos, but they are in other parts of Asia as well, including in Yunnan province where we just went on China Alive! In China this group is referred to as the Miao. This ethnic minority has traditionally lived in mountain and areas which are landlocked. Because of this, they have maintained their ancient belief system and have very h This book was so interesting and very moving. I learned a lot about the Hmong community that has settled in many parts of the United States. The Hmong are mostly from Laos, but they are in other parts of Asia as well, including in Yunnan province where we just went on China Alive! In China this group is referred to as the Miao. This ethnic minority has traditionally lived in mountain and areas which are landlocked. Because of this, they have maintained their ancient belief system and have very highly developed spiritual beliefs and practices, many of which are health-related. They believe that your mental health affects your physical health in all kinds of concrete ways. The title of the book is the translation of epilepsy in the Hmong language. The author explains the beliefs of the Hmong through the case of a Hmong baby girl in Merced, California, named Lia. She has severe epilepsy as a baby and her parents seek treatment though the medical community in Merced. They have huge communication issues with the Western doctors. When they do understand, they disagree with how Lia should be treated, particularly with the huge amount of medication that the doctors prescribe for her. Lia's parents and doctors all do their absolute best to help her and are impacted by her condition in so many ways. I do not want to reveal too much here, but I will say that I was riveted by Lia's story and had an emotional reaction to the end of the book.

  23. 4 out of 5

    El

    A little Hmong girl slammed the front door once and her three month old sister had what the medical community call an epileptic seizure. The Hmong family referred to it as quag dab peg which translates to "the spirit catches you and you fall down". It was the beginning of a long series of similar seizures, and the beginning of a long series of difficulties between the Hmong and American cultures. Lia Lee and her family were refugees living in Merced, CA when the spirit first caught Lia in this wa A little Hmong girl slammed the front door once and her three month old sister had what the medical community call an epileptic seizure. The Hmong family referred to it as quag dab peg which translates to "the spirit catches you and you fall down". It was the beginning of a long series of similar seizures, and the beginning of a long series of difficulties between the Hmong and American cultures. Lia Lee and her family were refugees living in Merced, CA when the spirit first caught Lia in this way. Lia quickly became well known at the medical center where she was taken each time she was sick; but the medical community is hugely different from the Hmong culture with a different set of beliefs and rules and expectations. The medical center physicians wanted to treat Lia with medication from the get-go - but the language barrier made that difficult, not to mention the medications went against the Lee's entire belief system. On the Lee side they met the doctors with distrust and suspicion; on the physician side they met the Lees with often disgust and accusations of non-compliance. This was an incredibly hard book for me to read. I work in a medical environment and certainly see the positive effects of medication and surgery. But I can understand the other side of this story too - a family that doesn't speak English, watching things being put in their daughter with very little interpretation, being told if they don't do x then y would happen, being told everything they have practiced for years (that appear to most Americans as just being naively superstitious); I can't imagine the fear the family must have felt. Every culture feels they know best, that their practices are the most appropriate, that everything else is sub-par. I had to read this book slowly, in small chunks, because I would find myself frustrated with the Lee family the same way the physicians were frustrated with them - I found myself saying, "If you just gave Lia the medication the way the doctors told you, she wouldn't be so sick...", and then immediately I would feel disgust at myself. At other times I found myself saying, "American doctors have no clue - listen to your patients...", and I found myself questioning the things I say and do every single day at work. I found myself on both ends of the spectrum, and each time I had that overwhelming feeling of frustration I knew it was time to put the book down. This, I imagine, is what Anne Fadiman was going for when she wrote this book. She wants her readers to be able to see both sides of the story, that neither one is especially right while neither side is especially wrong either. It's a fine and delicate line that must be straddled, but who is to say which is the right way to straddle it?

  24. 5 out of 5

    Chrissie

    Having now finished the book, I know Lia's fate. You must read the book to find out. No spoilers here! It is important to note that this book should be read by those not only interested in anthropology and how medical practices could/should be improved, but also those wanting to learn more about the Silent War in Laos. So many have been written about the war in Vietnam and so few about that in Laos. How do you teach doctors to feel empathy and love for their patients? Physical contact is one quick Having now finished the book, I know Lia's fate. You must read the book to find out. No spoilers here! It is important to note that this book should be read by those not only interested in anthropology and how medical practices could/should be improved, but also those wanting to learn more about the Silent War in Laos. So many have been written about the war in Vietnam and so few about that in Laos. How do you teach doctors to feel empathy and love for their patients? Physical contact is one quick trick. And how many doctors look you in the eye? We all know when a doctor is really communicating with us honestly. One doctor said she simply could not follow all the "cultural rules" that were necessary when communicating with the Hmongs....but they did feel her sincerity. She explained that the Hmong patients knew she was American and thus would be lenient. Body language says a lot. If we care, really care, that message gets across most cultural divides. Empathy has a therapeutic effect. But it sure helps if we make sure doctors don't have 33 hour shifts and access to interpreters. ******************* Through page 148: This is VERY hard for me to read...... To clarify: I am scared to death when I enter a hospital. Everything always goes wrong. My own fears/experiences clearly augment my empathy for Lia. Nevertheless, this is a book that needs to be read by everyone. I HAD to take a breather from the book, to write this. I felt physically ill. Writing gives me some distance. On an intellectual level, reading this after The Sacred Willow: Four Generations in the Life of a Vietnamese Family is just perfect. The themes intersect. Although Fadiman's skills are top notch, I must note that I am not completely sure the problem is only cultural. All people misunderstand each other in tense situations, even those of the same culture. I would also like to state that sometimes medicine fails. We, as patients, have a hard time accepting this. I do not know, at this point what will happen to Lia...... but we must also accept that there is not a medical solution to every problem. Will Lia die? I don't know. I think if she dies, there is not one culprit. Cultural misunderstanding has played in, definitely, but also medical science today is not full-proof and doctors are only human. Even the best make mistakes. These are my thoughts as I read this wonderful book.

  25. 5 out of 5

    Bonnie Brody

    I first read this book about three years ago and recently re-read it. I am a socal worker and educator but I have been giving copies of this book to everyone I know because it is relevant to anyone who has any interactions with people of different cultures. It reads like a novel and is a page-turner. It is also loaded with information and written in a literary and beautiful style. The book focuses on the clash between Hmong culture and traditional western medicine. The story is of one little girl I first read this book about three years ago and recently re-read it. I am a socal worker and educator but I have been giving copies of this book to everyone I know because it is relevant to anyone who has any interactions with people of different cultures. It reads like a novel and is a page-turner. It is also loaded with information and written in a literary and beautiful style. The book focuses on the clash between Hmong culture and traditional western medicine. The story is of one little girl with a seizure disorder whose family seeks help from California doctors. The Hmong have a complicated and almost mythological belief system based on centuries of narrative. Their views on health and healing are complex and many of these beliefs are not easily translated into the English language. English may have no word that does justice to the Hmong concept. How the family belief system and their desire to help their daughter results in a terrible clash with the medical doctors in the U.S. is examined by Ms. Fadiman in an exacting and compassionate way. She shows empathy for the Hmong family and the physicians who are trying to treat a girl with a life-threatening illness. The doctors feel like the family is non-compliant and the family feels that they much adhere to their spiritual belief system and treat their daughter in a way much differently than recommended by her physicians. I can't imagine anyone not loving this book, not being able to relate to some experience where they felt that their belief system was not understood by another for any reason. I highly recommend it for a wonderful read and to enhance one's knowledge of the difficulty of trying to truly understand another's cultural beliefs.

  26. 5 out of 5

    Irene

    "The parents of one small boy emptied his intravenous bottle refilling it with a green slime of undetermined ingredients- herbal home brew made by the Hmong parents for ages. Hmong patients made a lot of noise in the hospital which annoyed their American counterparts. They sometimes wanted to slaughter animals in the parking lot or hospital room of a sick relative. One resident recalls" they would bang the crap out of some musical instrument while visiting sick relations and the American patient "The parents of one small boy emptied his intravenous bottle refilling it with a green slime of undetermined ingredients- herbal home brew made by the Hmong parents for ages. Hmong patients made a lot of noise in the hospital which annoyed their American counterparts. They sometimes wanted to slaughter animals in the parking lot or hospital room of a sick relative. One resident recalls" they would bang the crap out of some musical instrument while visiting sick relations and the American patients close-by would complain. Finally we had to have a talk with them and tell them "No Gongs and No Dead Chickens!" Excerpt from The Spirit Catches You and You Fall Down II. The customs they were expected to follow were so numerous and seemed so peculiar, rules and regulations were hard to learn, many Hmong were simply overwhelmed. Some newcomers wore nightgowns as street clothes, poured water on electric stoves to extinguish them, lit charcoal fires in their livingrooms;stored blankets in their refrigerators; washed rice in the toilet; washed clothes in swimming pools; washed their hair with Lestoil; cooked dinner with motor oil & furniture polish, drank clorox bleach; ate cat food;planted crops in public parks; shot and ate skunks, woodpeckers, porcupines,robins,sparrows, egrets, a bald eagle, and hunted pigeons w a crossbow in the city streets of Philadelphia." pages 187-188

  27. 4 out of 5

    N.

    Christ, what a ride. I thought this book would be dry and unreadable. I had to read this for my Cultures & Madness class and write a book report (that I still haven't done). While there are times that it can be dense, it is very well written. Ms. Fadiman writes about the Hmong with incredible gravitas and emotionality. I don't know how she did it but, by the time I finished the book I was all teary. Sure, it could be that I haven't slept in days (finals) but I think it's because of how the s Christ, what a ride. I thought this book would be dry and unreadable. I had to read this for my Cultures & Madness class and write a book report (that I still haven't done). While there are times that it can be dense, it is very well written. Ms. Fadiman writes about the Hmong with incredible gravitas and emotionality. I don't know how she did it but, by the time I finished the book I was all teary. Sure, it could be that I haven't slept in days (finals) but I think it's because of how the story of this little Hmong girl touched me so deeply that it broke my heart to finish this book. It changed the way I see parenting, it changed the way I see the American medical system, it changed the way I see the Hmong whom I knew about thanks to Grey's Anatomy. This book is not a happy book. It's actually sad, heartbreaking, morally complicated but manages to be uplifting at the same time. Again, I don't know how Ms. Fadiman does it. This book teaches us to be human and to keep empathy in the front of our minds and hearts whenever we encounter someone of a different culture. It's so easy to judge. It's so easy to hate. Empathy, kindness... those are the some of the tools that can change the world or at the very least, make it a little less worse. I enjoyed this book immensely.

  28. 5 out of 5

    Erik Carlson

    Nowadays, if you use the term “cultural competency” in progressive medical education circles you are often met with open contempt. I never fully understood why that was until reading this book. How could one, even after a lifetime of research, ever hope to fully understand - to become competent in - a culture that is not their own? If I was Lia Lee’s physician, even at my most empathic, I would have no clue how to begin reconciling the Hmong view of disease with my own. I guess one can only hope Nowadays, if you use the term “cultural competency” in progressive medical education circles you are often met with open contempt. I never fully understood why that was until reading this book. How could one, even after a lifetime of research, ever hope to fully understand - to become competent in - a culture that is not their own? If I was Lia Lee’s physician, even at my most empathic, I would have no clue how to begin reconciling the Hmong view of disease with my own. I guess one can only hope that if ever placed in a similar situation, one will have the humility to listen and respond to the needs of the patient in a way that treats the pathology without neglecting the illness. Moving beyond the medical, this book exposed me to a culture, a people, and a part of world history of which I was completely ignorant. Fadiman’s masterful storytelling weaves anthropology, history, and narrative into a compelling thriller, ultimately leaving you with more to ponder than when you first began.

  29. 4 out of 5

    Seamus Ronan

    Just as relevant to a white teacher in the South Bronx in 2018 as to a resident at Merced Community Medical Center in 1986.

  30. 5 out of 5

    Kaion

    Anne Fadiman does a good job of laying out some of the complexities of the case of Lia Lee from the various viewpoints of her doctors, family, social workers, and other caretakers. However, reviews had me expecting something more of an exploration of cross-cultural medicine, or medical ethnography, and the turn in the later half of the book threw me in for a bit of a loop. I appreciated that Fadiman really got into explaining Hmong culture and beliefs towards medicine and disease -- the title ref Anne Fadiman does a good job of laying out some of the complexities of the case of Lia Lee from the various viewpoints of her doctors, family, social workers, and other caretakers. However, reviews had me expecting something more of an exploration of cross-cultural medicine, or medical ethnography, and the turn in the later half of the book threw me in for a bit of a loop. I appreciated that Fadiman really got into explaining Hmong culture and beliefs towards medicine and disease -- the title refers to the Hmong name of the condition Lia's doctors eventually diagnosed as epilepsy -- but as she turned to Hmong/Hmong-American culture and history as a whole, I felt Fadiman may have fallen into the trap of too much explaining. As in the Lees needed to be explained. I've been reading a lot about our cultural understanding of medicine and illness a lot lately, and The Spirit Catches You and You Fall Down fits well into that discussion along with The Emperor of Maladies and Illness as Metaphor in offering thought on how medical culture and culture as a whole have an non-minor effect on treatment development and disease outcomes. There's a bit of an assumption in this book that the actions of underlying culture of the medical establishment in the case are perfectly recognizable and understandable and therefore do not need to be analyzed, and that the actions of the Lees arise out of the clash between Hmong and American rather than out of a problem with the doctor-patient(-caretaker) paradigm as a whole. I am someone who's been brought up to believe in the whole modern drugs/medicine deal, but have engaged with it only in the caretaker/patient role and never in the doctor role. And I found myself sympathizing with Lees. I recognized the feeling of being nothing more than a bundle of symptoms to be measured and prodded and fixed. This dehumanization, being reduced down to a disease, is not an alien feeling to anyone who has suffered a chronic or persistent illness, or has taken care of someone who has. That's why I found it a little offputting when Fadiman "explained" the episode of the Lees trying to take their daughter from the hospital with something like: "The Hmong's historical response to outside authority imposing upon Hmong cultural autonomy is to flee. Here's an account two hundred years ago of Hmong migrating to get away from Chinese authority." (As a culture, are so deeply repressed about death and dying that we cannot empathize with the simple feeling of loss? Do we so deeply idolize health that we have forgotten sickness? Worse than forgotten, the ill are the other. Alien residents in our promised land of perpetual youth.) In reaching to historical explanations, Fadiman might have as well have found a Salem resident among the ancestors of Dr. Neil Ernst and Dr. Peggy Philp, whose existence explained their distrust of "witchcraft" and spirit healing. Instead, she revels in the detail that the couple alternate running eight miles before dawn every morning. Lia's doctors are consistently characterized by their marriage of equal minds, strong wills, and able bodies. Fadiman flirts with the anthropological fallacy wherein the behavior of people of the describer's own "group" are ascribed to individual traits, whereas behaviors of "other" peoples are explained by cultural ones. Instead of exploring why the medical (doctor) culture in which Ernst/Philp were entrenched made cross-cultural communication so difficult, Fadiman explains their foibles from their high-achieving perfectionism. Of course, this criticism has more to do with the book I expected to read than the one I got. The Spirit Catches You and You Fall Down I got explores of the intersection of the life of Lia Lee with the cultural clash that arose from the mass migration of Hmong immigrants to Merced. Fadiman obviously spent a lot of time reaching out and researching the people involved, and the end result is a meticulous piece of journalism. Rating: 3.5 stars

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